Agenda item

To consider a report by the Head of Regional Collaboration (copy attached) which seeks the Committee’s observations on the work being taken forward under the auspices of the North Wales Regional Partnership Board in response to the Audit Wales report on patient flow out of hospital.

10.05am – 10.50am

The Lead Member for Health and Social Care and the Corporate Director: Social Services & Education (CDSSE), alongside the Acting Assistant Director – Care Homes Support and Continuing Health Care Commissioning and Director of Public Health (BCUHB), presented the Urgent and Emergency Care: Flow out of Hospital – North Wales Region report (previously circulated).The aim of the report was to provide an updated account/information to partners regarding the associated work undertaken since the first publication of the Audit Wales report and combined organisational response in September 2024.

The Committee were informed that overall, it was found that whilst partners understood and showed a commitment to improving patient flow out of the hospital, performance remained extremely challenging with adverse effects on patient experience and care. Partners continued to work both individually and collaboratively to set and implement clear guidance, mitigate the challenges posed by reduced capacity and increased complexity of care, and ensure the impact of activities was continually monitored, challenged, and maximised.

The original report found that the extent of discharge delays in North Wales had grown significantly in recent years. Between April 2023 and February 2024, each month, there were, on average, 334 medically fit patients whose discharge was delayed, with completion of assessments the leading cause for delay. For the year up to and including February 2024, the total number of bed days lost to delayed discharges was 71,871, with a full-year cost equivalent of £39.202 million. The consequent impact on patient flow within hospitals and the urgent and emergency care system was significant, with waiting times in emergency departments and ambulance handovers falling well short of national targets. In February 2024, there were over 8,000 lost ambulance hours because of handover delays, and the average wait within the Health Board’s emergency departments was around 8.5 hours. Difficulties with discharge also impacted the ability of partner organisations to meet some patients' needs effectively, especially in the west of the region, where a significant proportion of patients were placed in temporary accommodation post-hospital discharge.

Members drew attention to several areas within the report and discussed the following further –

• whether the continual negative press/media coverage received by the Health Board contributed to the difficulties encountered in recruiting staff at all levels, thus impacting the flow in and out of the hospital.  Officers responded that negative press coverage was an issue. However, it had no impact on staffing, and the staffing levels were acceptable in all disciplines other than mental health, which was still proving challenging to hire staff.
• the steps being taken to ensure that vulnerable patients were not discharged home in the middle of the night with no one to receive them when they arrived. What support was made available to them to make sure they fully understood when and how to take their medication etc and whether any follow-up visits were scheduled. Responding officers acknowledged there were issues with the discharge process and agreed with members that vulnerable people should not be discharged in the middle of the night. BCUHB officers emphasised that vulnerable patients should not be discharged in the middle of the night and without support.  If this was happening it should be reported as an incident.  The Health Board held hourly discharge data, which was closely monitored, and worked closely with the community health team to ensure follow-ups were being carried out. 
• The Health Board had recently finalised its hospital discharge policy win cooperation with the local authority and other stakeholders.
• whether communication channels were sufficiently effective to ensure that patients deemed medically fit for discharge were  provided with proper support to aid their discharge. Officers clarified that a lot of work and communication was carried out with patients on discharge.  They were provided with leaflets containing all relevant information and contact details.  There was ongoing work to improve the information sharing between organisations and improving communication throughout. Further work was being undertaken in a bid to streamline the discharge process through the introduction of an electronic process.  In addition, Optimal Flow Facilitators had now been employed with a view to improving patient flow in and out of hospital.  At present all three Optimal Flow Facilitators were focussing their work at improving the flow in and out of Ysbyty Glan Clwyd.  Regarding support and carers, officers clarified that they strived to provide local care for residents, and the use of micro providers assisted with this.
• the Regional Integration Fund (RIF) monies and queried whether officers believed the funding would continue beyond 2027.  Officers informed the Committee that they were continuously discussing the RIF monies and potential funding post-2027 with the Welsh Government (WG).
• the report was a regional overview and was not solely focused on Denbighshire.  Its findings and recommendations along with the progress in delivering the identified actions were discussed at the North Wales Regional Partnership Board (NWRPB).  It had initially been presented to the Governance and Audit Committee which suggested the report be brought to scrutiny.  The delay in its presentation to Scrutiny was due to the democratic process of the report being sighted by the relevant bodies before being discussed at the current meeting.
• ‘RIF slippage monies’ would accrue when a role was vacant and had not been filled for some time.  Whilst the post was vacant the funding would be reallocated where required.
• Officers clarified that each organisation on the NWRPB contributed towards the work of delivering the action plan.
• With regards to delayed discharges Members were advised that these usually entailed complex needs which required multidisciplinary team meetings to fully assess the individual’s care needs.  Delay codes  were being reviewed nationwide with a view to simplifying the procedure.
• A member of the Single Point of Access (SPoA) team was now located at the hospital with a view to co-ordinating service enquiries more effectively.
• With regards to sickness absence levels officers reassured members that there had been a slight increase in sickness absences.  However, when working in health or social care, unlike other sectors, people could not work when suffering with sickness bugs, colds etc. due to the risk of passing them on to vulnerable clients, this caused short-term illness statistics to increase.
• Members raised concerns about the lack of local knowledge from secondary care providers, as many agency workers did not know the local area and could not locate people appropriately. Other concerns were the IT systems used by the health and social care sector the perceived lack of synergy between them.  Officers advised that there were ongoing meetings with WG, which aimed to focus more on community-based care, and there was ongoing work to get the IT systems working better together.
• Confirmation was provided that work was underway to streamline pharmacy services in a bid to improve the discharge process.
• Officers confirmed that partnership working arrangements were strong and positive, neither partner was blaming each other.  It was the media that was attempting to create divisions.  The NWRPB was working to improve the service provided regionally, with cooperation and joint working.  This approach at times required some compromises, but it was realising its objectives.
• Advised that in order to enable residents to live fulfilling lives there was a need to reframe the narrative and move the focus from a hospital centric system to a community care one.  This required a shift to a preventative and early intervention approach in primary and community care.
• Confirmation was provided that regular maintenance plans were in place for critical and specialist equipment at the hospitals.
• The Committee agreed that it would be prudent to have a follow-up information report on the action plan as soon as possible.

At the conclusion of a comprehensive discussion the Committee:

Resolved: 

(i)   to confirm that it had read, understood and taken into account the work that was required on a continual basis to meet the expectations and improve hospital flow in North Wales;

(ii) that the Lead Member and officers take note of the Committee’s observations on the work undertaken to date through the North Wales Regional Partnership Board to address the recommendations; and

(iii)                that a further Information Report on the progress made in delivering the combined organisational action plan in response to the Audit Wales recommendations be circulated to Committee members when available.

At this juncture the Committee adjourned for a comfort break at 12.55pm and reconvened at 1pm.